PPNNE to get “retroactive” $$ from state?

Part 1 of 2

Planned Parenthood of Northern New England may be in line for “retroactive” contract money via the state of New Hampshire, according to a public exchange among Executive Councilors Chris Pappas (D-Manchester) and Colin Van Ostern (D-Concord) and Department of Health and Human Services Commissioner Nick Toumpas during the June 19 meeting of the New Hampshire Executive Council.

The “retroactive” money, if paid, would apply to Title X family planning funds for 2014-2015 for the parts of the state covered by PPNNE, retroactive to July 1, 2013, according to the discussion at the meeting. If I understand the exchange between Pappas and Toumpas from the official recording of the meeting, this odd situation arises from the 2011 rejection of a PPNNE contract by the last Executive Council. (The Title X discussion begins about one hour into the recording and lasts 15 minutes. Note that the X is a Roman numeral, not a letter.)

Further, Commissioner Toumpas said in his public remarks that the state has been working with PPNNE “on a different benefit that’s going to go into place on July 1, a limited Medicaid benefit that is outside of anything that is called Medicaid expansion.”He offered no further information about that particular “benefit.”

The Council’s proceedings on June 19 illustrate the challenges facing New Hampshire residents who do not want their tax dollars going to abortion providers. Any legislative attempt to privatize Planned Parenthood, or any other abortion provider, will eventually have to be enforced by the executive branch of government.

I know Title X funds can’t be used directly for abortion. I also know that every Title X family planning dollar that goes to an abortion provider frees up other funds in the provider’s budget to keep abortions going. Therein lies the concern over Title X contracts.

Title X contracts approved by Council last week

At last week’s meeting, councilors unanimously approved a total of ten contracts with various family-planning providers for 2014-2015, mostly community clinics around the state. Under the Title X program, federal dollars are granted to states, which then administer the funds. PPNNE was conspicious by its absence from the list of contractors. During last week’s Council meeting, this missing contractor was discussed at length.The exchange between the Councilors and the Commissioner sounded to me like a planned effort to put things into the public record that were missing from the written material made public before the Council meeting. Why be mysterious at all? Let’s go back two years.

Flashback to 2011

In June 2011, eleven Title X contracts came up for Executive Council approval. Each proposed contractor was to be responsible for a specific part of the state. This was supposed to be a routine matter. One of the proposed contractors was PPNNE, which had handled Title X family planning contracts for years. By itself, it covered 57% of the state; the other ten contractors combined covered the other 43%. PPNNE was the sole surgical-abortion provider among the contractors, though, and that caught the eye of Councilor Dave Wheeler. Wheeler was (and still is) a firm believer in keeping public money away from abortion providers. Wheeler’s vote against the PPNNE contract was no surprise, and neither was the Nay from Councilor Ray Wieczorek. What was stunning was the Nay vote from Councilor Dan St. Hilaire, who didn’t have a high profile – or indeed, any profile – on the funding issue. Result: PPNNE lost the contract, garnering support from only two councilors that day (Republicans Ray Burton & Chris Sununu).

The stuff hit the fan. PPNNE, unaccustomed to being turned away, sidestepped state approval. The agency sought and received a direct grant for family planning from the federal government. Meanwhile, its PP Action arm went to work. Knowing that attacks on Wheeler and Wieczorek were pointless, PP’s allies went after St. Hilaire. Signs like “Dan St. Hilaire wants to take away your birth control” started popping up.

(I continue to be amazed at how determined some people are to keep women dependent on government handouts for birth control. How is that policy not creepy?)

St. Hilaire and Wieczorek chose not to run for re-election in 2012, and Wheeler was defeated by Debra Pignatelli (whom he had defeated in 2010). Result: all five current Councilors are PP supporters. Now, Councilor Pappas refers to the 2011 contract rejection as “a little bit of a hiccup.”

PPNNE & family planning in NH:, post-2011

So what happened to PPNNE’s clients whose services would have been paid for by Title X after July 1, 2011? In a word, nothing. Dollars given to PPNNE directly by the federal government replaced dollars administered by the state of New Hampshire under Title X. Commissioner Toumpas last week didn’t explain to Councilors the details of that particular arrangement, saying it would be “inappropriate” for him to know what those details were.

I obtained a copy of the Title X contract letter submitted by DHHS to the Council for approval last week. The ten entities approved for contracts cover the state, excluding “the geographic areas of Cheshire and Rockingham Counties, and the towns of Lebanon and Claremont.” That tells me that those “geographic areas” are PP territory, and I assume that PP is currently providing family planning to clients using the money it received directly from the federal government in lieu of a conventional Title X contract in 2011.

Toumpas: “It’s not appropriate for me to know what they did.”

Councilor Pappas and Commissioner Toumpas put some information about PPNNE’s 2011 “sidestep,” and its implication for future state funding, on the public record. I transcribed this conversation from the recording of last week’s meeting. I have used bold-face text to highlight certain statements. Remarks within brackets are my own.

Pappas: I’ve asked you offline about this as well. These are family planning funds, and obviously there was an issue a couple of years ago – a little bit of a hiccup – with funding and contracts for family planning. And I’m curious, these funds that are contained in these contracts [note: the ten Title X contracts for 2014-2015] don’t appear to represent or cover the whole state. I’m wondering how future contracts will be dealt with with the remainder of the money that’s available for family planning.

Toumpas: What happened a couple of years ago, we had brought forth eleven contracts that in total covered the entire state. We serve around 26,000 people through the family planning/Title X dollars. Planned Parenthood of Northern New England had roughly 57% of those numbers in some of the more populated areas of the state. And the other 43% of the people were served by the other ten agencies. When we [NH Department of Health and Human Services] brought forward a contract, … the Planned Parenthood contract was rejected. What we ended up doing was … going to the federal government; we relinquished the dollars and therefore the responsibility that the state had, and that responsibility is now borne by the federal government, Office of Population Health, working directly with an entity that they would contract with. It turns out that they contracted with, and appropriately I believe, Planned Parenthood of Northern New England. So essentially we created a bifurcated model for the state so that there isn’t any one entity in the state that has oversight over the entire [family planning] program. … Last year- the grant awards come up every two years – last year we approached Planned Parenthood and said we wanted to go with a statewide proposal again. We did that, we had that discussion, a good discussion with them, and it was determined that they were going to pursue the grant independently of us. We went after it statewide. It’s not appropriate for me to know what they did. But in the end, the federal government granted money to the state [for the approved contracts] and granted money to Planned Parenthood [in lieu of its rejected 2011 contract with the state].

Dollars and cents, “equitable and proportional”

How much state-level money for family planning is in the upcoming budget?

Governor Hassan asked for $894,000 per year in 2014 and 2015 – a more than half-million-dollars-per-year increase over fiscal year 2013. See page 1045 of the Governor’s budget proposal. The House and Senate had no argument, preoccupied as they were with other matters within the state budget. Compare this to the budget request from DHHS, which asked for $344,000 per year for 2014-2015; this was close to level-funded compared to 2013.

Why is there a half-million dollar discrepancy? Commissioner Toumpas told the Council, “…we knew that the Governor had put money in, an additional half a million … but not wanting to issue a contract based on an unknown, we went with a more conservative [budget request].” In other words, DHHS couldn’t be sure the legislature would approve a budget that more than doubled last year’s state expenditures for family planning programs.

By the time of the June 19 Council meeting, all parties were confident that the extra half-million dollars would indeed be appropriated.

Toumpas: …as it’s progressed through the budget language right now, the roughly $850,000, it is our understanding the intent of the legislature and the governor’s office that those dollars would get distributed, I believe the words are ‘equitably and proportionately.’ So the contracts you have here right now [from the ten area agencies] don’t reflect that at a statewide level. What we will do, assuming the budget that is being discussed across the street survives for at least this appropriation, what we will do is then we will, going within the next couple of months, we will then make an adjustment and be able to direct the dollars, the appropriate dollars, into that region that is covered by Planned Parenthood of Northern New England. I believe we have adequate dollars within the contracts we have before you today so we won’t need to do any adjustments there. …I know the issue has been raised that dollars aren’t being directed to Planned Parenthood right now but again my commitment is that I would make that adjustment in a subsequent contract and that we will be going forward.

Pappas: So you haven’t actually determined the formula for distributing those dollars yet.

Toumpas: We have not. …It’s a formula that goes into it, and I don’t profess to know that off the top of my head.

Pappas: But you’ve taken into consideration, or you will, the footnote that will likely … [Toumpas interrupts]

Toumpas: Absolutely. The footnote will be the law that will guide what it is that we are doing. My understanding of what is the intent of the Governor’s office and the intent of the legislature are very clear.…The other question I believe that a couple of the Councilors have asked me is when we will have an opportunity to basically have a unified statewide program again. Because the grants are done every two years, our next opportunity will be calendar year [20]16. And so in calendar 2015, we will then go and submit our request for the funding that will cover a statewide level and that will be our next opportunity to basically bring it under one unified program.

Pappas: And so future dollars that will be contracted out will be retroactive to July 1, …in terms of dollars that will come as part of the budget once it’s approved in the next fiscal year.

Toumpas: Ah, for [20]14, that would be retroactive for the Planned Parenthood part of the state.

Coming in part 2: Councilor Van Ostern joins the discussion; “I think the Council botched this two years ago.”

(An earlier version of this post contained an erroneous date for House and Senate action on the state budget.)

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